Ultrasound-guided suprazygomatic maxillary nerve block in cleft palate surgery: The efficacy of adding dexmedetomidine to bupivacaine

Abstract

We have hypothesized that adding dexmedetomidine to bupivacaine in bilateral ultrasoundguided suprazygomatic maxillary nerve block (SMB) would provide prolonged postoperative analgesia following cleft palate (CP) repair. Children posted for CP repair were randomized to receive bilateral ultrasound-guided SMB, with either 0.15 ml/kg 0.25% bupivacaine on each side (B group; n = 40) or 0.5 µg/kg dexmedetomidine plus 0.15 ml/kg 0.25% bupivacaine on each side (BD group; n = 40). Children and Infants Postoperative Pain Scale (CHIPPS) was the primary outcome, the number of children required analgesia, the first time of rescue analgesia, the total nalbuphine consumption, sedation score, and time to feed were recorded. CHIPPS score was comparable between the two groups in the first 6 hours. However, it was significantly less in BD group than B group at 8 h, 12 h, 16 h, 20 h and 24 h postoperatively as well as the number of children required analgesia (7 vs. 26, respectively; P < 0.001) with delay of the first analgesic request (23.6 vs. 14.9 h) and reduced the total nalbuphine consumption (0.3 ± 0.7 vs. 2.1 ± 1.8 mg). Sedation score was higher in group BD at Postoperative Anesthesia Care Unit (P = 0.037). Time to feed was similar between both groups (P = 0.376). In bilateral SMB, the use of 0.5 µg/kg dexmedetomidine as an adjunct to bupivacaine 0.25% was associated with prolonged postoperative analgesia and decreased total analgesic consumption in children assigned for surgical correction of CP.

Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial

“…Comparatively, our results showed a significant reduction in NRS scores at 36 hours post-surgery, which coincided with the time of removal of the haemostatic agent (described as the most unbearable pain ever by most of the patients), as we used 1 ml dexamethasone as an adjuvant with an additional 1.5 mL of 0.5 % bupivacaine in the MNB. Similarly, Mansour RF and Abdelghany (15) showed that administering 0.5 µg/kg dexmedetomidine as an adjunct to bupivacaine 0.25 % in MNB to children assigned for the surgical correction of cleft palates resulted in prolonged postoperative analgesia and decreased total analgesic consumption.…”

Suprazygomatic Maxillary Nerve Blocks and Opioid Requirements in Pediatric Adenotonsillectomy

“…For this reason, we did not expect a difference in anesthetic requirements intraoperatively given that the incision was made immediately before block onset. Drawing from insights in the literature on cleft palates and SZMN blocks, 40,[67][68][69][70] it becomes evident that the block's effects on pain typically dissipate within the initial postoperative day. Although it is known that pediatric posttonsillectomy pain can be substantial for up to 7 days postoperatively, our study could not draw any conclusions from pain scores after discharge.…”

Perioperative pain management for cleft palate surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

“…The effect of dexmedetomidine as an adjuvant to bupivacaine for suprazygomatic maxillary nerve blocks was compared with blocks with bupivacaine alone in three RCTs. [22][23][24] Mansour and Abdelghany 22 investigated the effect of 0.5 mcg/kg dexmedetomidine as an adjuvant to bupivacaine 0.25% for maxillary nerve blocks. While postoperative pain was comparable to the control group during the first 6 postoperative hours, a clinically significant reduction in pain scores was found between 8 and 24 hours postoperatively in the dexmedetomidine group compared with bupivacaine alone.…”

“…In the three studies mentioned above, [22][23][24] basic analgesia was only mentioned by Mansour and Abdelghany. 22 The use of ultrasound guidance was described in two of the studies.…”